Re: Severe Leptospirosis- a case series and review

Abstract

CORRESPONDENCE Re: Severe Leptospirosis-a case series and review Editor-I read with interest the paper on severe leptospirosis by Habaragamuwa and Piyasiri 1 . Leptospirosis is a major public health threat to Sri Lanka. Sri Lanka is experiencing a sustained outbreak of Leptospirosis since 2008 2 . Despite having a major burden, scientific evidence on leptospirosis epidemiology, clinical disease and manifestations are scarce in Sri Lanka. The paper by Habaragamuwa et al provided a detailed description of severe cases. Leptospirosis disease diagnosis is often hampered by lack of point of care diagnostic tests. Ambiguity of clinical disease prohibits accurate clinical diagnosis of this disease. Repeated studies have shown that this condition could be mimicked by a range of tropical diseases, including Dengue 3 and Hanta virus 4 infections. In our study done during the 2008 outbreak, we showed that the sensitivity and specificity of clinical diagnosis of leptospirosis in Kegalle, Matale and Kandy was less than 60% 5 . Despite the fact that the paper by Habaragamuwa et al is providing vital information, use of the data presented in the paper as scientific evidence is questionable due to lack of standard diagnosis. This issue of diagnostic dilemma was one major point of discussion during the WHO Leptospirosis Epidemiology Reference Group (LERG) meeting, and the expert group decided diagnosis could be either presumptive or confirmed 6 . For presumptive diagnosis, clinical leptospirosis supported by a single sample serology test is needed, whereas for confirmation, antigen based diagnosis of paired sample serology test results are needed. Clinical symptoms alone would not be considered even for presumptive diagnosis. However, those could be treated as"possible" cases of leptospirosis. The data presented would be more usable in scientific literature if the diagnostic criteria were clearly defined and patients were classified as "possible" or "probable (presumptive)" cases. Use of standard definitions and criteria for diagnosis will always allow comparison of cases across studies and helpful in disease burden assessment.